Endoscopic Submucosal Dissection vs. Argon Plasma Coagulation for Esophageal Squamous Cell Carcinoma Adjacent to a Scar

Background Endoscopic submucosal dissection (ESD) is a standard treatment option for superficial esophageal squamous cell carcinoma (ESCC) and is generally attempted first even for metachronous lesions adjacent to a scar in Japan. Given that ESD can be challenging for such lesions, argon plasma coagulation (APC) is considered a therapeutic option instead of ESD for cEP/LPM lesions at our institution; however, its selection criteria are not well-defined and largely depend on the endoscopist’s discretion. This study retrospectively analyzed cases of superficial ESCC adjacent to a scar treated with ESD or APC to clarify the indications for APC. Methods We reviewed 256 cases of 364 ESCC lesions adjacent to a scar (ESD: 190 cases of 254 lesions, APC: 66 cases of 110 lesions) treated between January 2005 and June 2024. Patient characteristics (age, sex, and comorbid malignancies), lesion characteristics (tumor size, circumference, and lesion entirely located on a scar), and therapeutic outcomes (adverse events, recurrence, and long-term prognosis) were analyzed. Furthermore, APC-treated cases were stratified by recurrence status and compared based on tumor size, circumference, and lesion entirely located on a scar to identify risk factors for recurrence after APC. Results APC was selected more frequently for older patients (median 73 vs. 69 years, p < 0.05) and for lesions entirely located on a scar (49.1% vs. 9.4%, p < 0.001). In contrast, ESD was selected for lesions with ≥1/2 circumferential involvement (59.4% vs. 10.9%, p < 0.001). Local recurrence rates were 22.7% for APC and 0.4% for ESD, with comparable five-year survival (80.7% vs. 84.2%). Among APC-treated cases, recurrence was associated with larger lesions (median 15 vs. 12 mm, p < 0.05) and ≥ 1/2 circumferential involvement (36.0% vs. 3.5%, p < 0.001), whereas lesions entirely located on a scar showed no significant difference in recurrence. Conclusion For superficial ESCC adjacent to a scar, if the lesion’s circumferential involvement is <1/2, APC is considered an acceptable alternative to ESD. Additionally, when the entire lesion is located on a scar, APC is also regarded as a favorable treatment option.